ANEMIA

Dr.Erwin Taher SpPK

Bagian Patologi Klinik
Fakultas Kedokteran UISU
MEDAN
-Pria : Kadar Hb < 14 gr/dl atau Hct < 42
%
Wanita : Hb < 12 gr/dl atau Hct < 37 %.

-Evaluasi lanjutan anemia, didasari :

(1) indeks retikulosit
(2) penilaian blood film dan indeks eritrosit
meliputi MCV, MCH dan MCHC
(3) penentuan stadium (akut/kronis anemi)
*Retikulosit Indeks :

Retikulosit count
RI =
Observered Hct / 2 X normal Hct

RI < 2% inadequate RBC production

RI > 2% Excessive RBC destruction or
loss
 Hematokrit (vol %)
MCV = X 10 ...... (FL)
Eritrosit (juta/mm3)

Hemoglobin (gr/dl)
MCH = X 10 .. (Pgr)
Eritrosit (juta/mm3)

Hemoglobin (gr/dl)
MCHC= X 100 ( % )
Hematokrit (vol%)
 Classification of Anemia
A.Relative
1. Macrroglobulinemia
2. Pregnancy
3. Athletes
4. Postflight astronauts

B.Absolute
1. Decreased red cell production
a. Stem cell failure
(1) aplastic anemia
(2) anemia of leukemia and of myelodysplastic synd
b. Progenitor cell failure
(1) pure red cell aplasia
(2) anemia of renal failure
 (3) Anemia of chronic disease
(4) Endocrine disorder (e.g.,hypothyroidisme)
c. Precursor cell failure
(1) megaloblatic anemia
(2) iron-deficiency anemia
(3) thalasemia
(4) hemoglobinopathy
(5) hereditary enzymes deficiency
2.Increased Red cell Destruction or loss
a. Hereditary
(1) membrane defects (e.g.,hereditary spherocytosis)
(2) globin defects (e.g., sickle cell anemia)
(3) enzyme defects (e.g.,PK def or G6PD def)
b. Acquired
(1) Macroangiopathy (traumatic)
 (2)microangiopathy
(3)antibody mediated
(4)hyperspleenisme
(5)acute blood loss
(6)paroxysmal nocturnal hemoglobinuria
manual hematology, williams ,p.28, 6 th ed, 2003
Anemia (excessive destruction or loss)
:
trauma ; GI bleeding ; genitourinary
(menorrhagia / gross hematuri) ; internal
atau retroperitoneal bleeding.

Pada perdarahan akut, biasanya didapati

manifestasi :hipovolemia, retikulositosis.

Pada perdarahan kronik, selalu disertai :

defisiensi besi dan gambaran mikrositer
hipokrom.
Anemia ( Hemolisis )
(1)-hiperspleenisme (pansitopenia)
(2)-Autoimmune Hemolitik anemia
Coombs test positive,spherocytes

2 tipe autoantibodi yang menyebabkan lisis

Warm antibodi (IgG) : Idiopathy, Limfoma,
CLL, SLE, Drugs (methyldopa, penicilin,
quinidine, INH, Sulfonamid)
Cold antibodi (IgM) : infeksi mycoplasma,
mononucleosis, Idiopathy.
(3) Mechanical trauma micro/macroangiopathy
hemolitic, schistocytes :
vasculitis, malignant hipertensi, graft
rejection, HUS, DIC, eclampsi.

(4) Direct toxic effect infection (malaria,

clostridia, toxoplasma )

(5) Kelainan membran sel eritrosit :

spur cells (cirrhosis, anorexia nervosa) ; PNH;
hereditary elliptocytosis

(6) Kelainan intrasellular : G6PD def, PK def, Hb pathy,

Thalasemia, sickle cell
 Abnormalitas Laboratorium
-Blood Film :Peningkatan RI, polikromasi,RBCs
nucleated
-Blood Film : spherocytes, elliptocytes, target,
sickle cell (tergantung pada gangguan yang
mendasari)
-Peningkatan billirubin indirect dan LDH
-Peningkatan Hb plasma, penurunan haptoglobin
-hemoglobinuria, hematuria,hemosiderinuria
-Coombs test (+)
-Osmotic Fragility Test
-Hb elektroforesis